-Â Â Â Â Â Â Â Â Â make sure health systems are resilient and can face epidemics as well as long-term challenges such as an ageing population and inequalities in health status.

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Through the EU4Health Programme, the Commission proposes to invest €9.4 billion in strengthening health systems. This is compared to the previous Commission proposal for a health strand under the European Social Fund+ of €413 million. The funding will partly come from the EU budget (€1.7 billion), partly via external assigned revenues, stemming from the borrowing operations of the Union as set out in the EU Recovery Instrument Regulation (€7.7 billion). There will be no pre-allocation for each of the objectives mentioned in the programme. The distribution will be agreed upon during the implementation of the EU4Health programme.

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Background

This proposal provides for a date of application as of 1 January 2021 and is presented for a Union of 27 Member States.

“We will stop at nothing to save lives,” said President von der Leyen, speaking to the European Parliament on 26 March 2020, the COVID-19 crisis is the biggest challenge the European Union (EU) has faced since the Second World War, and it has demonstrated that if each country tries to tackle pandemics on its own, the EU will be as weak as the weakest link. Every health system has struggled in tackling this crisis, and this has affected every citizen in one way or another.

Europe needs to give a higher priority to health, to have health systems ready to provide state of the art care, and to be prepared to cope with epidemics and other unforeseeable health threats in line with the International Health Regulations (IHR).

The new Programme will be essential in making sure that the EU remains the healthiest region in the world, has all possible tools available to address health challenges at national and EU level and is prepared for any new emerging health threat that may endanger the population of the EU.

Embedded in the ‘One health’ approach, which recognises the interconnection between human health and animal health and more broadly with the environment, the EU4Health Programme can support Member States in the transition to better preparedness and the reinforcement of their health systems and support them in achieving the health-related United Nations Sustainable Development Goals (SDGs). It provides for new actions, which will fill in gaps that this pandemic has revealed in terms of the development and manufacturing of medicinal products, the adequate supply of equipment in hospitals and sufficient medical human resources, the uptake of digital tools and services that enable continuity of care, and the need to maintain access to essential goods and services in times of crisis. This will allow the EU to have more tools to take quick, decisive and coordinated action with the Member States in both preparing for and managing crises.

I forward here below an interesting update from DG SANTE on how the different Member States should strengthen their health systems, in the framework of the European Semester and the recommendations the Commission just published.

Best regards,

Ilaria

e-News

20/05/2020

Health and Food Safety Directorate General

| Â Twitter Food | Â Twitter Health

Public Health

European Semester: All Member States should strengthen resilience of their health systems

Today, the Commission adopted proposals for country-specific recommendations that require each Member State to take steps to strengthen the resilience of its national health system. It is the first time, in the wake of the ongoing COVID-19 crisis, that the Commission has proposed health recommendations to all Member States.

The health crisis triggered by the COVID-19 pandemic has revealed an apparent need to ensure and strengthen the resilience of the EU’s national health systems, i.e. their capacity to efficiently tackle shocks, such as the COVID-19 epidemic, as well as longer-term structural changes to shield against any potential future crises.

Overall, COVID-19 has aggravated the performance of several countries that, prior to the onset of the pandemic, were already experiencing structural and long-term challenges related to the resilience, accessibility and efficiency of their health systems. These challenges have been the subject of various country-specific recommendations in the past.

The proposals for health recommendations are tailor-made to each Member State. They take into account specific structural challenges related not just to the short-term resilience of the respective health system (e.g. to ensure the availability of intensive care beds and of critical medical products such as personal protective equipment and ventilators), but also to the access to and the effectiveness of health care.

Among the longer-term issues highlighted in the wake of the COVID-19 crisis are the working conditions of doctors and nurses and shortages of health workers, as well as the insufficient financing of certain health system segments. High out-of-pocket payments and unmet needs for medical care for patients are also an issue, which can disproportionately affect the most vulnerable. Additionally, in some Member States the crisis has shown an insufficient capacity of the primary care sector.

The crisis also brought to the fore the untapped potential for the deployment and use of e-Health services, with insufficient coordination and cooperation between health care providers, and a limited integration of health and social care services, in particular elderly care.

The country-specific recommendations on health are as follows:

Austria

Improve the resilience of the health system by strengthening public health and primary care.

Belgium

Reinforce the overall resilience of the health system and ensure the supply of critical medical products.

Bulgaria

Mobilise adequate financial resources to strengthen the resilience, accessibility and capacity of the health system, and ensure a balanced geographical distribution of health workers.

Croatia

Enhance the resilience of the health system. Promote balanced geographical distribution of health workers and facilities, closer cooperation between all levels of administration and investments in e-Health.

Cyprus

Strengthen the resilience and capacity of the health system to ensure quality and affordable services, including by improving health workers’ working conditions.

Czechia

Ensure the resilience of the health system, strengthen the availability of health workers, primary care and the integration of care, and deployment of e-Health services.

Denmark

Enhance the resilience of the health system, including by ensuring sufficient critical medical products and addressing the shortage of health workers.

Estonia

Improve the accessibility and resilience of the health system, including by addressing the shortages of health workers, strengthening primary care and ensuring the supply of critical medical products.

Finland

Address shortages of health workers to strengthen the resilience of the health system and improve access to social and health services.

France

Strengthen the resilience of the health system by ensuring adequate supplies of critical medical products and a balanced distribution of health workers, and by investing in e-Health.

Germany

Mobilise adequate resources and strengthen the resilience of the health system, including by deploying e-Health services.

Greece

Strengthen the resilience of the health system and ensure adequate and equal access to healthcare.

Hungary

Address shortages of health workers and ensure an adequate supply of critical medical products and infrastructure to increase the resilience of the health system. Improve access to quality preventive and primary care services.

Ireland

Improve accessibility of the health system and strengthen its resilience, including by responding to health workforce’s needs and ensuring universal coverage to primary care.

Italy

Strengthen the resilience and capacity of the health system, in the areas of health workers, critical medical products and infrastructure. Enhance coordination between national and regional authorities.

Latvia

Strengthen the resilience and accessibility of the health system including by providing additional human and financial resources.

Lithuania

Strengthen the resilience of the health system, including by mobilising adequate funding and addressing shortages in the health workforce and of critical medical products. Improve the accessibility and quality of health services.

Luxembourg

Improve the resilience of the health system by ensuring appropriate availability of health workers. Accelerate reforms to improve the governance of the health system and e-Health.

Malta

Strengthen the resilience of the health system with regard to the health workforce, critical medical products and primary care.

Netherlands

Strengthen the resilience of the health system, including by tackling the existing shortages of health workers and stepping up the deployment of relevant e-Health tools.

Poland

Improve resilience, accessibility and effectiveness of the health system, including by providing sufficient resources and accelerating the deployment of e-Health services.

Portugal

Strengthen the resilience of the health system and ensure equal access to quality health and long-term care.

Romania

Strengthen the resilience of the health system,Â including in the areas of health workers andÂ medical products, and improve access to health services

Slovakia

Strengthen the resilience of the health system in the areas of health workforce, critical medicalÂ Â products and infrastructure. Improve primaryÂ Â care provision and coordination between types of care

Slovenia

Ensure the resilience of the health and long-term care system, including by providing the adequate supply of critical medical products and addressing the shortage of health workers.

Ensure the resilience of the health system, including through adequate supplies of critical medical products, infrastructure and workforce.

UnitedÂ Kingdom

Strengthen the resilience of the health system.

The proposals for country specific recommendations will now be discussed in the Council, where Member States will discuss and vote on their final adoption. After their adoption, the Commission will monitor the implementation of the recommendations.

Here’s POLITICO’s rundown of some of the main elements and the potential impact for key sectors of the EU’s economy.

INDUSTRY

Key figures: The Commission proposed two new funding streams to save beleaguered companies and invest in strategic value chains. It’ll allocate €5 billion from the current EU budget and €26 billion from the recovery fund for a Solvency Support Instrument aimed “at those companies that are in greatest need of capital across all member states and sectors.” That should ultimately generate up to €300 billion in private investment. The other instrument, dubbed the Strategic Investment Facility, is meant “to increase Europe’s resilience by building strategic autonomy in vital supply chains at the European level.” The Commission plans to put up €31.5 billion (which is supposed to trigger €150 billion in investments).

Potential impact: The solvency instrument would be primarily aimed at countries which don’t have the ability to distribute state aid, and those countries and sectors hardest hit by the crisis. It will be welcomed by poorer countries which risk seeing businesses go under, but is unlikely to stall the wave of bankruptcies if it isn’t agreed and deployed quickly.

How does this fit with the EU’s policy goals? The Strategic Investment Facility would invest in things like 5G, artificial intelligence, hydrogen and offshore wind. The investment guidelines for the Solvency Support Instrument “will also reflect the need to prioritise green investments,” the Commission wrote.

First reactions: Business representatives are keen to get the money fast. “From a business perspective, the question is as much about ‘how soon?’ as ‘how much?’… Our businesses cannot wait another six months for the roll out of much needed support,” said Christoph Leitl, president of Eurochambers, the association representing Europe’s chambers of commerce.

COHESION

Key figures: Cohesion programs would be allocated €323 billion from the EU budget over seven years — less than the €330 billion proposed in 2018 — but would get a top-up of €50 billion in recovery money from borrowed funding. The Commission is also asking for a boost of €5 billion for cohesion programs in the current EU budget, something that would entail countries injecting emergency cash into the bloc’s coffers over the coming months.

Potential impact: When it comes to the €50 billion, funding would go toward goals such as repairing labor markets, short time work schemes, support for health care systems, youth employment and helping small and medium-sized enterprises. The Commission is revising its rules to give countries extra flexibility on how to spend cohesion funding.

How does this fit with the EU’s policy goals? Green groups think not well. “By giving member states greater flexibility on how they will use EU regional development funds until as late as 2022, and by derailing programs from green objectives later, the EU runs the risk of more polluting activities being subsidized,” said Climate Action Network Europe’s Markus Trilling.

First reactions: The most contentious element of the proposal is how the new €50 billion would be allocated. Commission figures seen by POLITICO show the biggest beneficiary of the overall recovery funding is Italy, followed by Spain and Poland. France, one of the bloc’s wealthiest countries, would also qualify for significant sums. This approach is likely to be subject to intense negotiations. “Fair access to money for the real needs of member states is a key for the MFF compromise we all need,” Polish Minister for European Affairs Konrad Szymański said Wednesday.

AGRICULTURE

Key figures: European farmers would get €348 billion through the Common Agricultural Policy — an extra €24 billion from what the Commission envisaged in 2018. It adds a €20 billion top-up for rural development, which funds most of the greener farming projects in the bloc, of which €15 billion will come in borrowed money. There’s also a €4 billion add for direct payments to farmers.

Potential impact: Despite the boost, the plans would still see spending reduce by around €34 billion compared to the current budget cycle. That comes as agriculture sectors reel from the impact of the coronavirus crisis. A Commission analysis out Wednesday predicted EU agri-food companies could lose up to €37 billion in equity due to the pandemic.

How does this fit with the EU’s policy goals? The Commission presented the rural development boost as money to help farmers transition to more sustainable agriculture and meet the aims of the Green Deal. But whether the EU’s budget will really lead farmers toward greener pastures largely depends on the shape of the next CAP legislation, still in painstakingly slow discussions by EU institutions.

First reactions: The chair of the European Parliament’s agriculture committee Norbert Lins described the rural development boost as a “significant achievement” but added “we insist that the post-2020 budget for the EU farm policy must in no way be smaller than the current one.” Green groups including Greenpeace likened the move to increase rural development funding while maintaining vast subsidies to farmers to putting lipstick on a pig.

CLEAN MOBILITY

Key figures: The Commission said a massively expanded InvestEU package — beefed up to a total of €31.6 billion through borrowed money under the recovery fund — could go in part to drive investment in electric car charging facilities and greening urban transport. That would include using the Strategic Investment Facility to help funnel money into technologies that are “key” in the transition to clean energy, including batteries and hydrogen.

Impact: The Commission’s own estimates said the transport and automotive sectors could lose between €91 billion and €152 billion due to the crisis. In comparison, this is small change.

How does this fit with the EU’s policy goals? Transport has been caught in the Commission’s headlights, as it stressed in its communication that public money to reboot the EU’s transport sector should be matched by “a commitment from industry to invest in cleaner and more sustainable mobility.” But there are question marks over just how clean the transport investment plans are. “Spending big on shared and electric mobility is the right thing to do, but this plan leaves the door wide open for polluting engines and even airplanes to get stimulus money,” green lobby Transport & Environment’s William Todts said, warning of a “worrying lack of detail” on what would constitute green investment.

(Other) first reactions: With hydrogen on track to scoop up funding under the new Strategic Investment Facility, industry was happy. The fuels industry, too, called the proposal for the facility “encouraging.”

HEALTH

Key figures: The Commission proposed spending €9.4 billion on a new health program called EU4Health. The majority of that big figure — €7.7 billion — would come in borrowed funds from the recovery instrument, with €1.67 billion from the EU budget. Still, this is a huge change since 2018 when the Commission proposed allocating only €413 million from the EU budget to health. Plus, funds allocated to rescEU — part of the EU’s disaster protection mechanism and used to stockpile medical goods during the corona crisis — will increase to €3.1 billion.

Potential impact: The idea is that the funding from the recovery pot can be used to shore up national health systems to help with this crisis as well as any future virus outbreaks, with funding for laboratory capacity, as well as tools to monitor and forecast outbreaks. The Commission wants to build its ability to procure supplies such as ventilators and protective clothing and equipment, as well as a coronavirus vaccine if and when one is developed.

How does this fit with the EU’s policy goals? The new proposal would see the health program become independent — and the Commission stressed that’s because its ambitions in health go beyond solving the immediate crisis. The longer-term vision includes more efforts on prevention and improving access to diagnosis and treatment. It will also fund the creation of a European Health Data Space to encourage the exchange of health data to promote research.

First reactions: The health bubble is championing the standalone big health program as a major win. The European Public Health Alliance, for one, wrote that public health is “finally” getting “the recognition it deserves.” German MEP Tiemo Wölken is happy that the Commission’s proposal reflects proposals pushed by his S&D party. And unsurprisingly, Health Commissioner Stella Kyriakides is a fan of the plan, calling it “A game changer for our health.”

ROADS AND RAIL

Key figures: The Commission wants to spend €12.8 billion from the EU budget for the 2021-2027 period on transport infrastructure from the Connecting Europe Facility — an extra €1.5 billion on top of what it suggested back in May 2018. But a proposal for a military mobility program has been slashed to €1.5 billion from nearly €6 billion originally, after capitals ground the first proposal down during earlier negotiations.

Potential impact: The infrastructure funding would help cover the cost of some mega projects that need finishing, not least Rail Baltica, which the Commission’s plan named explicitly as a priority. That will go down well with the Baltics. But ultimately it’s a relatively small amount of money for meeting the bloc’s infrastructure goals.

How does this fit with the EU’s policy goals? The crisis shone a new light on the “crucial role” of transport as disruptions threw economies into disarray, the Commission said. The extra cash matches its new-found appreciation, but defense is no longer a priority, and that includes investment for roads and railways that can shift both troops and passengers around Europe.

First reactions: Greens MEP Karima Delli, who heads the Parliament’s Transport and Tourism Committee, said the Commission “hasn’t been ambitious at all when it comes to transport,” despite its “key role” in the crisis.

DIGITAL

Key figures: The Digital Europe program is to get €8.2 billion over seven years, an increase of €1.5 billion from the Council’s February draft and the full amount initially proposed by the Commission in 2018. Proposed investment in digital infrastructure through the Connecting Europe Facility comes to €1.8 billion.

Potential impact: The money will be used to develop electronic identities that work across the bloc and build “strategic digital capacities and capabilities,” including artificial intelligence, cybersecurity, secured communication, data and cloud infrastructure, 5G and 6G networks, supercomputers, quantum and blockchain.

How does this fit with the EU’s policy goals? The Commission has resisted pressure from EU countries to cut digital funds as it looks to boost Europe’s industrial and technological prowess. But it’s not clear if the funds will be enough to meet the bloc’s aims — with, for instance, an ambitious Data Act. That would create a European single market for data and encourage the Continent’s industrial heavyweights to share data and feed artificial intelligence applications; data sharing has moved into the limelight with the coronavirus, as senior officials tout it as another way the bloc can fight the pandemic.

First reactions: Leading tech lobby Digital Europe was not impressed. “Digital technologies are the backbone of a resilient society. It is therefore puzzling that the dedicated funds for digital – the Connecting Europe Facility and the Digital Europe Programme – have not been given any extra funding,” said Director General Cecilia Bonefeld-Dahl.

CLIMATE

Key figures: The Commission backed increased spending on the Just Transition Fund, Brussels’ signature scheme for helping to clean up industry, from an original €7.5 billion planned to a total €40 billion. That would include €30 billion of borrowed money. Overall the Commission wants 25 percent of budget spending to go toward meeting climate goals (a target it hasn’t increased since its 2018 proposal).

Potential impact: Brussels’ plan might force industry to speed up their greening efforts. Under the proposals, public coronavirus recovery investments should “do no harm” and follow the bloc’s energy and climate priorities (although that’s not binding). Countries would have to design national recovery plans to access €560 billion of the recovery fund in line with their national climate plans. Brussels also wants the new taxonomy criteria — an EU framework now being finalized for what constitutes sustainable investments — to “guide investments.”

How does this fit with the EU’s policy goals? The Commission’s Green Deal project calls for the bloc to become climate neutral by 2050. There had been fears that the pandemic response would gut that goal as countries raced to prop up their economies. But the Commission has insisted it won’t abandon the longer-term climate goal, and a range of initiatives from the just transition to hydrogen and battery initiatives show that the recovery and the budget do have something of a green tint.

First reactions: Campaigners said there aren’t enough controls to ensure recovery investments go toward hitting the bloc’s climate goals or explicitly excluding investments in fossil fuels. WWF said the plans don’t ensure countries won’t invest in “harmful activities such as fossil fuels or building new airports and motorways.” Friends of the Earth Director Jagoda Munic said “too many of the measures fall short of the goals of the European Green Deal.”

RESEARCH AND INNOVATION

Key figures: The Horizon Europe research fund would get a total €94.4 billion under the proposal, including €13.5 billion in borrowed money from the EU recovery fund. The amount allocated directly from the EU budget was reduced from the Commission’s 2018 proposal.

Potential impact: The Commission says the additional money through the recovery fund will help make progress tackling coronavirus — whether that be through vaccine research or improving the science that governments are using daily to make decisions on how to manage the crisis.

How does this fit with the EU’s policy goals? The move shows the Commission’s plans to commit in particular to more research on health — but the decision to reduce the amount of proposed funding from the EU budget in favor of shorter-term recovery funds (which may also be spent on different things) raises questions over its longer-term commitment to research and innovation as a policy objective.

First reactions: German conservative MEP Christian Ehler said the figures were hugely problematic for the bloc’s ambitions for an economic recovery and tackling climate change: “Not having a significant increase of the European research budget is not just disappointing, it is almost suicidal.” Cecile Vernant, head of development NGO Deutsche Stiftung Weltbevoelkerung (DSW)’s EU office said she was “delighted” to see the EU commit more to health research.

ENVIRONMENT

Key figures: Under the budget proposal, the LIFE fund for environment and climate would increase from €3.2 billion in the current budget cycle to €4.8 billion. Plus, there’s money for environmental aims among the €196 billion allocated to the European Regional Development Fund (part of cohesion funding) and the €90 billion of agriculture money for rural development.

Potential impact: In addition to money spent on environmental protection in the budget, von der Leyen said that the money spent on recovery “should be consistent with the Union’s climate and environmental objectives,” without detailing much how this would work in practice. Green MEP Bas Eickhout also warned during a debate in plenary that this principle seems to apply only to public investments in the recovery,Â and not the €1.1 trillion of the EU budget, thus leaving the door open to EU financing of polluting sectors.

How does this fit with the EU’s policy goals? The Commission proposed an ambitious strategy on May 20 to stop biodiversity loss, with the objective of placing 30 percent of the EU’s land and seas under a protected status and slashing the use of chemical pesticides by 50 percent by 2030. However, to reach those high ambitions the bloc must overcome an investment gap of an estimated €68 billion per year — a target unlikely to be reached by the allocated money.

First reactions: Environmental groups welcomed the overall proposal but pointed out that direct investments into nature protection and pollution prevention were still missing. “The Commission’s proposals fail to address the enormous problem of toxic pollution, which is a major threat to our health,” said Jeremy Watson, secretary-general of the European Environmental Bureau, an NGO. The European Parliament will also not be pleased: Previously MEPs demanded at least 10 percent of the budget (similar to the number proposed by environmental groups) be earmarked for biodiversity conservation.

today the European Commission presented itsÂÂ Recovery plan for Europe, to help repair the economic and social damage brought by the coronavirus pandemic, to kick-start European recovery, and to protect and create jobs.

The Commission is proposing a major recovery plan based on harnessing the full potential of the EU budget,putting forward a two-fold response:

Â 1)Â Next Generation EU: a new recovery instrument of €750 billion which will boostÂÂ the EU budget with new financing raised on the financial markets for 2021-2024

Â 2Â A reinforced long-term budget of the EU for 2021-2027:The Commission remains fully committed to delivering on its flagship initiatives, the Green Deal, the digital transition, a fair and inclusive recovery, a more resilient Europe which are key to relaunching the European economy.

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WHAT's IN IT FOR HEALTH?

The European Commission's proposed a standalone health program, EU4Health, which will have a budget of €9.4 billion, according to a Commission document.

Up until now, the EU's health budget has been part of the European Social Fund.

The Commission laid out a number of health-related aspects in its Multiannual Financial Framework and Recovery Instrument proposals, including investing more in health systems; improving coordination between countries; and fighting medicine shortages.

Here’s what we know so far:

— Health systems: The Commission will invest more in health systems and create a long-term vision for “for well-performing and resilient public health systems.”

— rescEU: Part of the EU's disaster protection mechanism, rescEU will get more cash for its emergency response infrastructure, transport capacity and emergency support teams, while creating an EU reserve of essential medical supplies and equipment to be used in emergencies.

— Drug shortages: The Commission document stressed the importance of creating a secure supply of active pharmaceutical ingredients. The proposed solution is a new “Strategic Investment Facility,” which will "support cross-border investments to help strengthen and build European strategic value chains." More details will be spelled out in the Commission’s new pharmaceutical strategy to be published in the fourth quarter.

— EU agencies: The European Medicines Agency should get beefed-up authority to monitor drug shortages, while the European Centre for Disease Prevention and Control should have more power in "coordinating surveillance, preparedness and response to health crises.”

— Health data: The new plan would create a European Health Data Space to encourage the exchange of health data to aid research. This idea was included in earlier Commission plans.

— Research: The Commission will reinforce Horizon Europe to support health research, which "will be essential" in the development of vaccines and treatments, while making the EU more independent in supply chains.

— Procurement: The Commission wants to strengthen the "EU's health regulatory framework" and its ability to procure items, including a vaccine "in the immediate term."

— Global cooperation: The Commission is proposing supporting “global partners” by strengthening the Neighborhood, Development and International Cooperation Instrument and the Humanitarian Aid Instrument. The Commission also reaffirmed its commitment to working with international organizations like the World Health Organization and G7, and to making any vaccine against the coronavirus available and affordable for the world.